Why Surgical Masks versus Cloth Masks at OP and Spectrum

The topic of wearing masks during this pandemic can be a sensitive one. If we constrain the focus to looking at the effectiveness of masks in preventing the spread and risks of contracting the coronavirus, the topic becomes less controversial.

In reviewing over 89 studies, it has become clear based on this evidence that masks are helpful in preventing the spread and contraction of corona virus. One of the most through and exhaustive reviews on the topic is available from the researchers at examine.com here.  If you want to dive deep into the evidence, yet have a very readable reference, that would be the place to start.

Meanwhile, I would like to highlight how we have taken the available evidence and applied it to our policies that we are recommending all of our employees, vendors, patients, clients, or anyone who enters our clinics and studios follows.

Specifically, we will focus on why we are now requiring the use of surgical masks instead of other masks. In addition, I will share the evidence that proves wearing a surgical mask while exercising does not cause any harm.

The goal is to provide a clear rationale regarding our mask policy in efforts to keep you and our team in optimal healthy during the pandemic.

 

Why Surgical Masks

Based on available evidence, surgical masks are more effective than other types of masks, except n95 respirators, in preventing the spread of respiratory droplets from the wearer.  A direct comparison was made in a study from Duke, comparing 14 different types of masks. (Fischer, E.P., et al. Science Advances, 2020)

The results of the study are below:

The first pic shows the types on mask studies. In green, I marked which ones scored best (1) to worse (14). The second is the data table.

While this does not provide direct evidence of the efficacy of masks, it does provide indirect evidence that N95 and surgical masks perform better than other types of masks.

 

So why not require N-95 masks?

There are 3 main reasons: they aren’t much more effective than surgical masks, they are in limited supply, and they aren’t practical.

A meta-analysis of 4 randomized control trials (the most robust types of evidence) found that N95 and surgical masks equally protect health care workers against viral infections such as coronaviruses in the environment of non-aerosol-generating care (such as typical to our clinics/studios).  (Bartoszko JJ, et al. Medical Masks vs N95 Respirators for Preventing COVID-19 in Health Care Workers A Systematic Review and Meta-Analysis of Randomized TrialsInfluenza Other Respir Viruses. 2020).  Another study showed that when 41 heath care workers were exposed to aerosols from patients with COVID-10, none of the contracted the virus and 85% were wearing surgical masks. (Ng K, et al. COVID-19 and the Risk to Health Care Workers: A Case ReportAnn Intern Med. 2020)

N95 masks also require custom fitting, are more expensive, and are uncomfortable to wear. Accordingly, the researchers, CDC, and local health departments recommend they are reserved for healthcare workers working in high risk environments.

 

Aren’t cloth masks just as good as surgical masks?

The direct comparison from the above Duke study show that some are comparable while others far worse in preventing droplet spread, which theoretically relates to their effectiveness in preventing the spread of COVID.

A randomized control study showed that health care workers earing cloth masks were 13 times more likely to contract flu-like illnesses compared to those wearing surgical masks. (Abd-Elsayed A, Karri J. Utility of Substandard Face Mask Options for Health Care Workers During the COVID-19 Pandemic.Anesth Analg (2020).

There are many other studies that show variable effectiveness of different types of mask. Some of these studies distinguish the effectiveness from protecting the wearer from getting the virus vs protecting the wearer from spreading the virus to someone else. The trend of the evidence is in favor of using surgical masks.

One of the biggest problems in evaluating the utility of cloth masks is that there are so many different types of cloth masks, as you can see from the above picture. These different types vary in their theoretical effectiveness. It is impractical to visually determine whether someone is wearing a cloth mask is wearing a 3-ply cotton or a single ply more porous cotton mask, for example. Thus, we believe it is best to require surgical masks in our clinics and studio.

 

Is it safe to wear a surgical mask when you exercise?

Yes, it has been well established that wearing a surgical mask does not pose any harm to the wearer while exercising.

A recent study in Canada investigated the effects of wearing a surgical or cloth mask compared with wearing no mask in healthy individuals exercising vigorously. The results showed no difference between mask wears and non-mask wears in performance, arterial oxygen saturation, tissue oxygenation index, rating of perceived exertion, or heart rate at any time during the exercise tests. (Shaw, K et al. Int. J. Environ. Res. Public Health. Nov 2020)

A significant body of research prior to this study supports these findings. You can read a more extensive review of the research pertaining to the safety of wearing masks that I wrote here.

I hope you found this helpful to further understand how we are applying the best available evidence and recommendations from the CDC and local health departments to keep you safe in our facilities while we help you to achieve optimal health and function. While the pandemic provides challenges, we will continue to adapt and not be deterred from helping you to get as strong, healthy, and resilient as possible. If this situation has taught us one thing, it’s that we must focus now more than ever on getting healthier. We’ll keep adapting and remain here to help you!